12 U.S. Health insurance terms
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12 U.S. Health insurance terms

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An overview of 12 common U.S. health insurance terms that could mean money out of our pocket.

An overview of 12 common U.S. health insurance terms that could mean money out of our pocket.

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12 U.S. Health insurance terms 12 U.S. Health insurance terms Presentation Transcript

  • 12 U.S. HEALTH INSURANCETERMS YOU NEED TO KNOW That Cost You Money
  • Major Disclaimer I am not an attorney – nor do I play one on TV The following guide does not constitute legal advice.
  • Does your health insurance Confuse you? Bore you? All of the above?
  • All you want to know is how much will it cost – right?
  • about 12 healthinsurance terms
  • about 12 healthinsurance termsand how they costyou money
  • Keeping it simple: 3 categories Money Provider Plan Terms Terms Terms
  • MONEYTERMS
  • #1 – PREMIUM THE PURCHASE PRICE FOR HEALTH INSURANCE The higher the level of coverage – the higher the premium
  • Do you have health insurance through your employer?
  • Do you have health insurance through your employer? Or do you purchase your own?
  • If you purchase your own Sorry you pay the entire premium cost At least for now
  • If your employer offers coverage look for health insurance term #2
  • #2 – CONTRIBUTIONS/COST-SHARING THE AMOUNT YOUR EMPLOYER CONTRIBUTES TO THE COST OF THE PREMIUM
  • There is no law requiring your employer to contributeAt least for now
  • #3 – DEDUCTIBLE THE AMOUNT YOU PAY BEFORE YOUR INSURANCE PAYS Think car insurance
  • Review your health plan booklet Deductible applies
  • #4 – COPAYMENT/COINSURANCETHE AMOUNT YOU PAYBASED ON THE TYPE OFHEALTH CARE RECEIVED
  • #5 – OUT-OF-POCKET LIMITTHE MAXIMUM YOU PAY ON COVERED SERVICES BEFORE YOUR INSURANCE PAYS 100%
  • #1 – PREMIUM #2 – CONTRIBUTIONS OR COST SHARINGMONEY #3 – DEDUCTIBLETERMS #4 – COPAYMENT OR COINSURANCE #5 – OUT-OF-POCKET LIMIT
  • PROVIDER TERMS
  • #6 – IN-NETWORK SERVICES HEALTH CARE RECEIVED FROM A PROVIDER WHO HAS A CONTRACT WITH YOUR HEALTH PLAN
  • #7 – OUT-OF-NETWORK SERVICES TREATMENT FROM PROVIDERS WHO DO NOT PARTICIPATE IN YOUR HEALTH PLAN’S CONTRACTED GROUP
  • Why should you care? Visiting network providers keeps money in your pocket
  • #8 – PRIMARY CARE PHYSICIAN A PHYSICIAN WHO MANAGES YOUR OVERALL HEALTH CARE Often your “family doctor”
  • Your health plan may requireThomas Jones, MDGeneral Practitioner you select a primary care physician (PCP)
  • Your health plan may requireThomas Jones, MDGeneral Practitioner you select a primary care physician (PCP) and receive referrals to specialists from your PCP
  • If you don’t get the referral it could cost you – big time
  • #6 – IN-NETWORKPROVIDER #7 – OUT-OF-NETWORK TERMS #8 – PRIMARY CARE PHYSICIAN
  • PLANTERMS
  • #9 – COVERED SERVICES LIST OF ELIGIBLE SERVICES FOR BENEFITS UNDER YOUR HEALTH PLAN
  • #10 – MAXIMUM ALLOWANCE THE HIGHEST DOLLAR AMOUNT YOUR HEALTH PLAN PAYS FOR A SERVICE
  • You could be left holding the bag for charges from an out-of-network provider
  • #11 – EXCLUSIONS AND LIMITATIONS LIST OF NON-COVERED SERVICES OR THOSE WITH BENEFIT RESTRICTIONS UNDER YOUR HEALTH PLAN
  • #12 – BRAND VS. GENERIC DRUGS DRUG WITH BRAND NAME THAT IS PROTECTED BY Brand™ PATENT Drug
  • #12 – BRAND VS. GENERIC DRUGS DRUG WITH BRAND NAME THAT IS PROTECTED BY Brand™ PATENT Drug SAME ACTIVE INGREDIENTS AS BRAND DRUG
  • Generic alternative saves moneyAsk your physician about generic drugs
  • #9 – COVERED SERVICES #10 – MAXIMUM PLAN ALLOWANCE #11 – EXCLUSIONS ANDTERMS LIMITATIONS #12 – BRAND VS GENERIC DRUGS
  • MONEY TERMS1. PREMIUM2. CONTRIBUTIONS – COST SHARING3. DEDUCTIBLE4. COPAYMENT – COINSURANCE5. OUT-OF-POCKET LIMIT
  • MONEY PROVIDER TERMS TERMS1. PREMIUM 6. IN-NETWORK2. CONTRIBUTIONS 7. OUT-OF- – COST SHARING NETWORK3. DEDUCTIBLE 8. PRIMARY CARE4. COPAYMENT – PHYSICIAN COINSURANCE5. OUT-OF-POCKET LIMIT
  • MONEY PROVIDER PLAN TERMS TERMS TERMS1. PREMIUM 6. IN-NETWORK 9. COVERED2. CONTRIBUTIONS 7. OUT-OF- SERVICES – COST SHARING NETWORK 10. MAXIMUM3. DEDUCTIBLE 8. PRIMARY CARE ALLOWANCE4. COPAYMENT – PHYSICIAN 11. EXCLUSIONS & COINSURANCE LIMITATIONS5. OUT-OF-POCKET 12. BRAND VS LIMIT GENERIC DRUGS
  • Learn health Check your Save insurance health plan money! terms
  • Questions? Ask your employer’s human resource professional
  • Questions? Ask your employer’s human resource professional Or your health insurance agent or representative
  • Legal stuffNotice of Disclaimer –Cathy Miller is not an attorney or health careprovider and cannot provide legal or health care advice.The information provided is for your general background only, and isnot intended to constitute legal or health care advice as to yourspecific circumstances.We recommend you review legislation with legal counsel and visityour physician for health care issues.Photo Credits: BigStock Photo
  • Download ebook 12 U.S. Health Insurance Terms You Need to Know: That Cost You Money www.SimplyStatedHealthCare.com/Free-Stuff
  • Cathy Miller, Business Writer Business site: www.SimplyStatedBusiness.com Health care blog:www.SimplyStatedHealthCare.com